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Left ventricular pacing improves haemodynamic variables in patients with heart failure with a normal QRS duration
  1. M S Turner,
  2. R A Bleasdale,
  3. C E Mumford,
  4. M P Frenneaux,
  5. J A Morris-Thurgood
  1. Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, UK
  1. Correspondence to:
    Professor M Frenneaux
    Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK; scacciacf.ac.uk

Abstract

Objectives: To assess whether patients with congestive heart failure (CHF) and a normal QRS duration can benefit from left ventricular (VDD-LV) pacing.

Design: Cardiac resynchronisation is reserved for patients with a broad QRS duration on the premise that systolic resynchronisation is the mechanism of benefit, yet improvement from pacing correlates poorly with QRS duration. In CHF patients with a broad QRS duration, those with a high resting pulmonary capillary wedge pressure (PCWP) > 15 mm Hg benefit. In this acute haemodynamic VDD-LV pacing study, patients with CHF with a normal QRS duration were divided into two groups—patients with a resting PCWP > 15 mm Hg and patients with a resting PCWP < 15 mm Hg—to determine whether benefit is predicted by a high resting PCWP.

Patients: 20 patients with CHF, New York Heart Association functional class IIb–IV, all with a normal QRS duration (⩽ 120 ms).

Interventions: Temporary pacing wires were positioned to enable VDD-LV pacing and a pulmonary artery catheter was inserted for measurement of PCWP, right atrial pressure, and cardiac output.

Results: In patients with a PCWP > 15 mm Hg (n  =  10), cardiac output increased from 3.9 (1.5) to 4.5 (1.65) l/min (p < 0.01), despite a fall in PCWP from 24.7 (7.1) to 21.0 (6.2) mm Hg (p < 0.001). In patients with a PCWP < 15 mm Hg there was no change in PCWP or cardiac output. Combined data showed that PCWP decreased from 17.0 (9.1) to 15.3 (7.7) mm Hg during VDD-LV pacing (p < 0.014) and cardiac output increased non-significantly from 4.7 (1.5) to 4.9 (1.5) (p  =  0.125).

Conclusions: Patients with CHF with a normal QRS duration and PCWP > 15 mm Hg derive acute haemodynamic benefit from VDD-LV pacing.

  • pacing
  • heart failure
  • QRS duration
  • left ventricle
  • haemodynamic variables
  • CHF, congestive heart failure
  • CRT, cardiac resynchronisation
  • LBBB, left bundle branch block
  • LV, left ventricular
  • PATH-CHF, pacing therapy in congestive heart failure
  • PCWP, pulmonary capillary wedge pressure

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